Infants and pre-school children
Infants and toddlers grow at a quick rate, so it is important to nourish their bodies with the nutrients and vitamins they need to support their long-term health and well-being. Knowing what to feed their children can be overwhelming for parents and carers.
Here, we’ll share some information about the nutritional needs of infants and toddlers/preschool children. It’s important to remember that every child is different, and what may have worked for one may not work for another. If you require further advice, we recommend speaking to your GP or booking an appointment with a nutrition professional.
Nutritional needs of infants
The World Health Organization recommends that, where possible, new mothers breastfeed their babies exclusively for the first six months of life before introducing solid foods alongside (up to two years of age or older). Breast milk is an extremely rich source of nutrition for newborns and infants and is packed full of antibodies that will help to establish a baby's immune system.
The NHS outlines the benefits of breastfeeding babies. These include:
- reduced risk of infections and diseases
- reduced risk of diarrhoea and vomiting
- reduced risk of SIDS (sudden infant death syndrome)
- building a strong bond between the parent and baby
Post-birth, for the first few days, the breasts will produce a yellow, thick, and sticky substance known as colostrum. This first milk is low in fat and rich in carbohydrates, protein, and antibodies which makes it ideal for newborns. The milk also has a laxative effect, helping babies to pass their first stools which assists in the flushing out of excess bilirubin, helping to prevent jaundice. Soon after giving birth, the colostrum will begin to change into thinner, whiter milk, with mature breast milk usually starting to come through on or around the third or fourth day after birth.
Should I avoid certain foods while breastfeeding?
There is no medical advice recommending that certain foods be avoided during breastfeeding. However, what you consume can pass through to your breast milk, so you may find that your baby is less likely to suckle if they are more sensitive to particular foods. For example, some mothers believe that strong foods such as garlic and acidic citrus fruits upset their babies. If you do have a hunch that this may be the case, then contact your GP before eliminating any specific foods to ensure that you are not inadvertently omitting any important vitamins or minerals.
Unless you have a specific allergy (to nuts, for example) there is no suggestion that these foods should be avoided either. If you suspect your baby might have an allergy or intolerance, speak to your GP.
Whilst there is no advice to suggest specific foods should be avoided, there are recommendations for some foods and drinks to be consumed in moderation.
- Caffeine - this is found in tea, coffee, chocolate, and some energy and soft drinks. Caffeine is a stimulant, so it can make your baby restless. Where possible, try to limit your caffeine intake to 300mg a day.
- Alcohol - it’s safer to avoid alcohol altogether when breastfeeding, but a small amount (one to two units a week) is unlikely to do any harm to your baby. There is also evidence to suggest that alcohol can affect the smell of breast milk which can subsequently affect your baby's feeding, sleeping or digestion.
- Fish - when breastfeeding, limit your consumption of mercury-containing fish (like shark) and don’t eat more than two portions of oily fish per week.
Possible breastfeeding problems
Despite the benefits of breastfeeding, it is certainly not for everyone and some people will opt to bottle-feed their babies formula milk for either medical (for example, breastfeeding is not recommended for those on certain medications) or personal reasons.
Breastfeeding can also bring on some problems such as:
- cracked/sore nipples - which can make it painful to breastfeed
- not producing enough breastmilk
- breast engorgement - the breasts get too full of milk, which can result in them becoming hard and painful
- difficulty in the baby latching
- blocked milk ducts/mastitis
Opting not to breastfeed will not mean you are missing an opportunity to bond with your child, nor are you being selfish. Good parenting is about love, guidance and respect, and, throughout life, these factors will be what your children come to rely upon.
If you would like to give your child breast milk but feel uncomfortable doing so, remember there is the option of bottle-feeding your baby expressed milk. Expressing is a way of taking milk from the breast without the baby suckling, and can be done by hand or with a manual or electric pump.
On the other hand, you may opt to feed your baby formula milk, the composition of which is considered a safe alternative to breast milk. The three main types of formula milk are as follows:
- Whey-based milk – usually intended for babies from birth, whey-based (or ‘first infant’) formulas have a similar balance of ingredients to that of breast milk and are thought to be easier to digest.
- Casein-based milk – casein is not as easy to digest as whey and therefore, supposedly, keeps your baby feeling fuller for longer. It is usually intended for slightly older babies with a growing appetite.
- Soya formula – some babies are intolerant to cow's milk formulas and in these cases, soya formula is used as a substitute.
Generally, it is recommended that parents feed their baby cow's milk-based formulas, but if you are unsure about which type of formula to choose, talk things over with your midwife or a health visitor.
It can be difficult to gauge how much milk your baby needs and wants, but general guidelines advise that from birth to six months, your baby will require an average of between 2 and 2.5 ounces of formula per pound each day. Don't be too concerned if your baby does not stick to these guidelines - the best way to gauge if your baby is healthy is to keep an eye on their weight and progress.
Though every baby is different, it is thought that feeding in small amounts often works best as the stomach of a baby is only tiny. Feeding your baby large amounts won't mean that they will go longer between feeds and it may cause adverse effects such as sickness and weight gain.
- Ensure you have the right equipment before your baby is born - it’s recommended to buy a few bottles so you can use and wash them interchangeably. Also, make sure you have sterilising equipment to help you keep your baby's bottles clean. During the first six months, it is important to sterilise equipment between every use as your baby is more vulnerable to infection.
- Follow their lead – when bottle feeding, pay attention to what your baby is doing. If they begin to squirm, remove the bottle as they may have had enough or need to burp.
- Follow instructions – don't try to rush things and guess formula amounts. You need to ensure that the proportion of water to formula is correct so your baby obtains maximum nutritional value.
- Keep some ready-to-feed formula as a backup – formula can also be bought ready-made in cartons which are great for when you are either on a trip or rushing out the door and don't have time to make up a bottle.
- Make bottles when needed – it may sound more time-consuming than making up multiple bottles in the morning and putting them in the fridge, but it is recommended you make a fresh bottle when it is needed and that you throw away any leftover milk.
- Make sure you buy recognised infant formula – in the UK, it is illegal to sell anything for your baby that is not a recognised formula that fulfils government guidelines on nutritional content.
- Temperature preference – some babies prefer warm milk and others will drink it from the fridge, so try to pay attention to your baby's preference. Always check the temperature of the milk to ensure it is not too hot by shaking a few drops onto the back of your hand.
Things to look out for when breast/bottle feeding
Diarrhoea and vomiting – it is normal for babies to regurgitate small amounts of milk at the end of their feed but anything else, such as vomiting after or between feeds, blood in the vomit or diarrhoea, is cause for concern and could result in dehydration or electrolyte imbalance. Alert your doctor to this immediately so that action can be taken. If your baby is dehydrated, they will need extra fluids and these can be given orally between feeds or after each watery stool. Continue feeding your baby as normal during this time and be careful to wash your hands regularly with soap and warm water to avoid spreading infection.
Poor weight gain – weight gain will usually be monitored by your midwife or a health visitor (though do keep an eye out yourself), either of whom will advise you if they feel your baby's growth rate is cause for concern. There are many factors that may contribute to poor weight gain, from using the incorrect formula to breastfeeding technique. If there is a problem, your midwife, health visitor, or doctor will let you know the steps which should be taken to promote healthy growth.
Excessive weight gain – excessive weight gain is quite rare in babies who breastfeed exclusively, yet while bottle-fed babies tend to grow more quickly, it is understood that some may end up being over-fed. Babies feed little and often so aim to pace your baby's feeds according to when they feel hungry. If you are concerned that your baby is gaining weight excessively, contact your health visitor.
Introducing solid foods: Complementary feeding
When your baby reaches six months it is recommended to begin introducing solid food in addition to breastfeeding or formula milk. At this stage, babies should be able to sit up, turn their heads and make chewing motions.
Complementary feeding vs weaning
‘Complementary feeding’ and ‘weaning’ are both terms used to describe the introduction of solid foods into a baby’s diet, however, the term ‘complementary feeding’ is more widely preferred by health professionals as this highlights that it should ideally be done alongside breast/bottle feeding.
When a new food is introduced, this should be done gradually and in small amounts, giving the digestive system ample time to adjust.
Try beginning with soft and mashed foods such as pureed apple, mashed banana, mashed potato or rice cereal mixed with breast milk or formula. Introduce anything new one at a time so that you can gauge your baby's reaction and, if they won't eat something at first, try them again with it later.
It is worth noting that a hungry baby may be less receptive to trying new foods, so it is sometimes best to feed them breast milk or formula as you usually would before getting them to try something new. Try to leave a couple of days before trying a different type of food and begin with very small quantities which can be built up over time (one to two teaspoons at first).
Babies spitting out their food and pulling faces is not necessarily an indicator of dislike and is more a way of showing they are experiencing a new sensation and taste. If they refuse a certain food, it may take a few more attempts before they decide if they like it or not.
At around nine months, your baby may be able to start picking up small pieces of food to feed themselves with. Alongside your normal feeding regime, try giving them little chopped-up pieces of soft foods such as banana, dry cereal, well-cooked pasta, etc. Each time you introduce something new, leave a gap of a few days so you can see if it causes an allergic reaction.
'Teething’ is the term used to describe the process of milk teeth breaking through the gums, usually beginning at around six to nine months. Though every child will differ, it can take up to two and a half years for a full set of teeth to come through and, during this time, a child may experience a variety of side effects that tend to cause discomfort and probably a few tears.
Symptoms of teething include:
- sore, red gums
- a mild temperature
- a rash on the face
- dribbling more than usual
- difficulty sleeping
- chewing on objects
To reduce irritation, try teething gel or powder massaged into the baby's gums, or infant paracetamol or ibuprofen. There are also various things that you can do to support your baby’s teething, such as using teething rings or giving soothing fruits and vegetables like melon.
Nutritional needs of toddlers and pre-school children
When children are between the ages of one and five, good nutrition is essential for child development of strong bones, teeth, muscles and a generally healthy body.
From one upwards, you can begin to start feeding your children what the rest of the family eats, providing a healthy, varied diet. To begin, you may have to cut the food, help with feeding and be there to provide general supervision and guidance. By the age of five, your child should be able to manage their mealtimes independently.
Young children are often full of energy and so their need for nutrients is high. Try to incorporate a wide range of healthy foods into their diet including fresh fruit and vegetables, starchy foods like potatoes, bread and rice, dairy, poultry, lean meats, fish, eggs and whole grains. Try and keep junk food to a minimum but feel free to give your children the occasional treat such as crisps or chocolate.
Constipation is a common problem in many children. Find out how to help your child manage and prevent this in this article by nutritional therapist, Jane Barrett.
Healthy eating for children
Key food groups
Try to make sure that your child is having the following every day to ensure they are receiving all of the essential nutrients needed for optimum growth and health.
When it comes to balancing their meals, it’s impossible for us to be calculating every nutrient that kids are eating and that’s why thinking about food groups can really help.
Baby and child nutritionist Charlotte Stirling-Reed
Carbohydrates - carbohydrates such as cereal, bread, rice and pasta are a good source of energy for active and growing children.
Fruit and vegetables – the government has recommended that everyone, including children, should aim for five portions of fruit or veg per day. However, this can be difficult to achieve if your child is a picky eater. Try incorporating fruit into puddings and smoothies, vegetables raw with a dip, or made into soups or sauces.
Milk and dairy foods - children need calcium in their diet for bone growth so you should try to incorporate some into your child’s diet. From the age of one, you no longer need to use formula milk and you can start to incorporate normal cow's milk. If your child isn't particularly keen on drinking lots of milk, you can add dairy in many other ways such as in yoghurts, sauces and cereals.
Protein – as an essential part of a child’s diet, protein is important for cell growth and survival, among other things. Some form of meat, fish or other protein sources should be eaten once or twice a day. Many nutritionists recommend two servings of fish per week, one of which should be oily, and any meat cooked should be tender to ensure chewing is not a problem. Good alternatives to meat and fish are eggs and pulses.
Fats - young children, and especially those under the age of two, require concentrated energy that is provided by fat. As children get older, they can have less fat in their diets, but healthy unsaturated fats remain important. These can be sourced from foods like oily fish, avocados, seeds and nuts. Saturated fats that are found in cream, cheese and fatty meats, on the other hand, should be limited.
For more information about nutrition for kids, head over to our kids' healthy eating hub.
Key vitamins and minerals
Vitamin A – supports the body’s immune system and promotes healthy skin and cell development. Vitamin A can be found in eggs, cheese and some vegetables.
Vitamin C - this helps the body absorb iron and helps keep cells healthy, as well as aiding wound healing. This vitamin can be found in citrus fruits and various vegetables.
Calcium - this nutrient is necessary for the healthy development of strong bones and teeth. Calcium is commonly found in dairy products.
Iron – plays a role in many essential bodily processes including making red blood cells that carry oxygen in the blood. Iron can be found in meat, certain dairy foods, some green vegetables and whole grains.
Zinc - is needed to help the body's hormones and enzymes to perform. It also supports the body’s immune system and is important for repairing damaged tissue. Zinc can be found in meat, fish, dairy, whole grains and nuts.
Though it can be very challenging (and sometimes worrying if you feel your child is not eating enough), it is very common for young children to refuse food. According to Great Ormond Street Hospital, one in three two-year-olds are thought to be ‘fussy’ eaters.
Fussy eating is rarely a cause for concern, as toddlers are still able to consume the right amount of nutrients to support their growth and development, even if their diet might seem limited. As long as they are eating some foods from the main food groups (veggies, starchy foods, proteins and dairy), they’re active, gaining weight and are well in themselves, you don’t need to worry.
If your child is losing weight, seems lethargic or has a temperature, contact your GP. There could be an underlying condition that explains their loss of appetite.
Children’s tastes are constantly changing. While it may seem disheartening if your child appears to have ‘gone off’ a certain food, keep going back to them as they may love it again later on. At the same time, you can gradually try to introduce other foods to see if your child likes something new; though remember, it’s not uncommon for children to refuse foods they’ve never eaten before, so don’t be discouraged if this is the case. If this does happen, remain calm and don't try to force-feed. Simply remove the food and try to introduce it again in a few days.
Tips for managing fussy eating
Whilst fussy eating cannot be avoided, there are some tips for helping parents and caregivers to manage their child’s eating habits:
- Have a routine - having a consistent breakfast, lunch and dinner routine with a healthy morning and afternoon snack can help the child feel more secure.
- Make the most of mealtimes - the best way for children to learn to eat food is by copying you, so try to sit down with them as much as possible. Eating as a family can make mealtimes more enjoyable. Sharing foods with each other and offering gentle guidance and praise can boost your child’s confidence in eating.
- Reward your child - if your child tries a new food or finishes their plate, praise them. It’s never recommended to offer them a sweet treat as a reward, as they might start to associate healthy foods as ‘yucky’. Instead, offer them a different kind of reward, such as playing their favourite game.
- Give them simple, healthy foods - young children are unlikely to know what they want to eat when asked, so present their foods to them simply and in small portions.
- Try different types of foods - you might find that your child doesn’t like cooked carrots, for example, so you could try offering them grated raw carrot, instead. Similarly, if you discover your child likes potatoes, try feeding them mashed, baked or roasted potatoes, too.
- Be patient - children are often slow eaters, so try to be patient with them. If they don’t eat everything or refuse food, try to remain calm as children can easily pick up on when their parents are feeling stressed. This will make the whole experience much more positive for both you and your child.
Finding a professional
Maintaining a healthy diet for your infant or toddler can seem overwhelming, but it’s important to remember that there is support available if you’re struggling. Whether you’re having trouble breastfeeding, want to know more about specific nutrients for your child’s needs, or you’re finding it hard to cope with your child’s fussy eating, contact a health professional or a nutritionist for further guidance.
At Nutritionist Resource, our members hold membership with a professional body, meaning they are qualified to offer nutritional advice. To find a professional near you or online, use our guided search.